There is great interest in identifying factors that can be used to predict cognitive decline. Research increasingly suggests that midlife risk factors may be particularly important for later cognitive decline and dementia, with cardiovascular health appearing to be particularly significant. An article in Neurology reports on a longitudinal study which compares two widely used cardiovascular and stroke risk assessments with a dementia-specific risk scale in terms of the assessments’ ability to predict later-life cognitive decline.
The investigators drew data from the ongoing Whitehall II study in England, which includes approximately 10,000 men and women who were between 35 and 55 years of age when the study began. Participants were given questionnaires every two and a half years, had a clinical examination every five years, and were administered cognitive tests three times over a period of 10 years. The three risk scales compared in the article were administered with the first of the three cognitive tests.
The questionnaires and exams included the risk scores that were assessed in the study. The Framingham cardiovascular disease risk score and the Framingham stroke risk score are two clinical assessments widely used in the United States and internationally. (These can be self-administered by following this link.) These two scales incorporate blood pressure, cholesterol, diabetes, and a set of behavioral and personal factors to predict individual risk for cardiovascular disease or stroke. Participants were also assigned a risk score based on the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) risk assessment, which has been suggested as a risk measure for the later development of dementia. It is important to note that the investigators were not assessing the scales for their utility in predicting dementia, but in predicting cognitive decline, which influences well-being and quality of life but does not always lead to dementia.
The authors’ analysis found that the cardiovascular disease risk and stroke risk, as measured by the Framingham risks scores, were associated with greater cognitive decline over the 10-year period. A high risk score on the Framingham scales was associated with decline in four of the cognitive measures included in the study, while a higher dementia risk was associated with three of the measures. The Framingham scales had a slightly stronger statistical association with cognitive decline than the CAIDE dementia risk scale.
These findings are promising because, as the authors note, middle-aged patients in a clinical setting are likely to be assessed for cardiovascular risk, while midlife dementia screening is not currently advocated. If these findings are replicated in other representative populations, patients could be told that their cardiovascular risk factors also may increase their risk of cognitive decline at an early enough point in life for preventive behaviors and treatments to reduce their risk.